Urology Coding Alert

Question: Could you please inform me of any upcoming changes or updates to the CPT^® codes for urology in 2025 that I should be aware of?

Nebraska Subscriber

Answer: There are a few new CPT^® codes that will be effective beginning January 1, 2025, for urology. We’ve reached out to Stephanie Stinchcomb Storck, CPC, CPMA, CUC, CCS-P, ACS-UR, longtime urology coder and consultant in Summerfield, Florida, to explain how these codes may be used in your practice.

New transurethral ultrasound ablation (TULSA) codes include:

• 51721(Insertion of transurethral ablation transducer for delivery of thermal ultrasound for prostate tissue ablation, including suprapubic tube placement during the same session and placement of an endorectal cooling device, when performed)
• 55881 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation)
• 55882 (Ablation of prostate tissue, transurethral, using thermal ultrasound, including magnetic resonance imaging guidance for, and monitoring of, tissue ablation; with insertion of transurethral ultrasound transducer for delivery of thermal ultrasound, including suprapubic tube placement and placement of an endorectal cooling device, when performed)

Storck states, “The TULSA procedure is a minimally invasive treatment for prostate cancer with granted FDA 510(k) [Food and Drug Administration] clearance since August 2019. During this procedure, ultrasound and MRI imaging are used simultaneously to target and destroy irregular prostate tissue.”

New codes created for ischemic remodeling of the bladder neck and prostate include:

• 53865 (Cystourethroscopy with insertion of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate)
• 53866 (Catheterization with removal of temporary device for ischemic remodeling (ie, pressure necrosis) of bladder neck and prostate)

“These codes are used to report describe insertion and removal services associated with the use of a temporarily implanted nitinol device (iTind) that remodels the bladder neck and prostate to alleviate symptoms of the lower urinary tract secondary to benign prostate hyperplasia,” Storck adds.

When cysts or tumors are excised or destroyed in the intra-abdominal region, urologic surgeons have been using CPT^® codes 49203 (Excision or destruction, open, intra-abdominal tumors, cysts or endometriomas, 1 or more peritoneal, mesenteric, or retroperitoneal primary or secondary tumors; largest tumor 5 cm diameter or less)-49205 ([....] largest tumor greater than 10.0 cm diameter). These codes have historically been selected based on the size of the single biggest cyst, endometrioma, or tumor that the surgeon addresses. The existing guidelines currently do not consider how many overall tumors are addressed.

The following intra-abdominal tumor excision codes have been revised or deleted:

CPT^® 2025 deletes codes 49203–5, which were based on the size of the largest tumor/cyst, and adjusts the reporting requirement to be determined according to the total size of all tumor/cysts removed that fit into the following definitions:

• 49186 (Excision or destruction, open, intra-abdominal (ie, peritoneal, mesenteric, retroperitoneal), primary or secondary tumor(s) or cyst(s), sum of the maximum length of tumor(s) or cyst(s); 5 cm or less)
• 49187 (…5.1 to 10 cm)
• 49188 (…10.1 to 20 cm)
• 49189 (…20.1 to 30 cm)
• 49190 (…greater than 30 cm)

“These new codes will enable surgeons to more specifically report destruction or excision of intra-abdominal tumors based on sum of the maximum length of the tumor or cyst,” says Storck.

Lindsey Bush, BA, MA, CPC, Development Editor, AAPC